Influência da variação dos decúbitos laterais na deposição pulmonar de aerossol

Alcoforado, Luciana; Filho, L Capelozza; Brandão, Daniella Cunha; Galvão, André Martins; Reinaux, Cyda; Andrade, Armèle Dornelas de

doi:10.1590/s1413-35552011000400004

Cited by 15 publications

(5 citation statements)

References 27 publications

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“…It is known that the regional distribution of ventilation in the supine position may be affected by body posture, with a predominance of ventilation in areas dependent on gravity [16][17][18][19] . However, the effect of different postures on PEF, particularly relevant for physical therapy, has yielded controversial results.…”

Section: Introductionmentioning

confidence: 99%

Effects of dorsal and lateral decubitus on peak expiratory flow in healthy subjects

Gianinis¹,

Antunes²,

Passarelli³

et al. 2013

Braz. J. Phys. Ther.

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| Background: One of the measures of the pulmonary function is the peak expiratory flow (PEF) that can be defined as the major flow obtained in an expiratory pressure after a complete inspiration to the level of the total lung capacity. This measure depends on the effort and strength of expiratory muscles, the airway diameter and the lung volume. Objective: To compare the results of the peak expiratory flow in healthy male and female obtained in a seated position and dorsal decubitus (DD), right lateral decubitus (RLD) and left lateral decubitus (LLD). Method: Thirty young subjects with mean age 22.7 years, healthy and non-smokers were included at the study, 15 of male sex. They did spirometry and IPAQ questionnaire to check the normal pulmonary function and physical activity level. The measures of PEF were performed in four positions, being performed 3 measures in which position, in a random order. Statistical analysis was performed according to Student's t test, with significance level set at 5%. Results: There was a difference between the values obtained in sitting position(481±117.1 L/min) with DD(453.2±116.3 L/min) and RLD (454±112.9 L/min) (p<0.05), however, did not find a significant difference between the sitting position and LLD (469±83 L/min). Conclusions: Body position affects the values of PEF, with decreasing values in DD and RLD. The LLD can be an alternative to optimize the expiratory flow in situations of constraint to the sitting position.Keywords: peak expiratory flow rate; meter; physical therapy. HOW TO CITE THIS ARTICLEGianinis HH, Antunes BO, Passarelli RCV, Souza HCD, Gastaldi AC. Effects of dorsal and lateral decubitus on peak expiratory flow in healthy subjects. Braz J Phys Ther. 2013 Sept-Oct; 17(5):435-441. http://dx

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Section: Introductionmentioning

confidence: 99%

Effects of dorsal and lateral decubitus on peak expiratory flow in healthy subjects

Gianinis¹,

Antunes²,

Passarelli³

et al. 2013

Braz. J. Phys. Ther.

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“…It is important to note that there was a change in the graphical behavior of the aeration on the dependent ROI in spontaneous mode, which was a decrease of a large magnitude in the difference between pre- and post-nebulization values and was different from the controlled and assisted MV modes. The decrease in total aeration and in the dependent pulmonary region suggest that the reduction in hyperinflation increased total and dependent pulmonary region ventilation [ 16 , 47 ].…”

Section: Discussionmentioning

confidence: 99%

“…As the pulmonary deposition of the aerosol is influenced by the ventilatory pattern and previous studies with computed tomography and EIT show that there are differences in ventilation distribution between the MV modes according to the proportion of ventilatory assistance and respiratory work developed by the patient, we can speculate that there are differences in ventilation and aeration between MV modes after bronchodilator aerosol therapy [ 14 , 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Influence of Mechanical Ventilation Modes on the Efficacy of Nebulized Bronchodilators in the Treatment of Intubated Adult Patients with Obstructive Pulmonary Disease

et al. 2023

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Background: Little has been reported in terms of clinical outcomes to confirm the benefits of nebulized bronchodilators during mechanical ventilation (MV). Electrical Impedance Tomography (EIT) could be a valuable method to elucidate this gap. Objective: The purpose of this study is to evaluate the impact of nebulized bronchodilators during invasive MV with EIT by comparing three ventilation modes on the overall and regional lung ventilation and aeration in critically ill patients with obstructive pulmonary disease. Method: A blind clinical trial in which eligible patients underwent nebulization with salbutamol sulfate (5 mg/1 mL) and ipratropium bromide (0.5 mg/2 mL) in the ventilation mode they were receiving. EIT evaluation was performed before and after the intervention. A joint and stratified analysis into ventilation mode groups was performed, with p < 0.05. Results: Five of nineteen procedures occurred in controlled MV mode, seven in assisted mode and seven in spontaneous mode. In the intra-group analysis, the nebulization increased total ventilation in controlled (p = 0.04 and ⅆ = 2) and spontaneous (p = 0.01 and ⅆ = 1.5) MV modes. There was an increase in the dependent pulmonary region in assisted mode (p = 0.01 and ⅆ = 0.3) and in spontaneous mode (p = 0.02 and ⅆ = 1.6). There was no difference in the intergroup analysis. Conclusions: Nebulized bronchodilators reduce the aeration of non-dependent pulmonary regions and increase overall lung ventilation but there was no difference between the ventilation modes. As a limitation, it is important to note that the muscular effort in PSV and A/C PCV modes influences the impedance variation, and consequently the aeration and ventilation values. Thus, future studies are needed to evaluate this effort as well as the time on ventilator, time in UCI and other variables.

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“…They also found that ventilation is forced to non-dependent areas and perfusion towards dependent areas [ 22 ]. The results of the study performed by Alcoforado et al suggest that quantitatively as qualitatively, aerosol deposition during nebulization is induced in the dependent areas of lungs when using a diaphragmatic respiratory pattern associated with a lateral decubitus position [ 23 ]. Our findings suggest less deflation in the parent lung.…”

Section: Discussionmentioning

confidence: 99%

The effect of posture on airflow distribution, airway geometry and air velocity in healthy subjects

et al. 2022

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Background Gravity, and thus body position, can affect the regional distribution of lung ventilation and blood flow. Therefore, body positioning is a potential tool to improve regional ventilation, thereby possibly enhancing the effect of respiratory physiotherapy interventions. In this proof-of-concept study, functional respiratory imaging (FRI) was used to objectively assess effects of body position on regional airflow distribution in the lungs. Methods Five healthy volunteers were recruited. The participants were asked during FRI first to lie in supine position, afterwards in standardized right lateral position. Results In right lateral position there was significantly more regional ventilation also described as Imaging Airflow Distribution in the right lung than in the left lung (P < 0.001). Air velocity was significantly higher in the left lung (P < 0.05). In right lateral position there was significantly more airflow distribution in the right lung than in the left lung (P < 0.001). Significant changes were observed in airway geometry resulting in a decrease in imaged airway volume (P = 0.024) and a higher imaged airway resistance (P = 0.029) in the dependent lung. In general, the effect of right lateral position caused a significant increase in regional ventilation (P < 0.001) in the dependent lung when compared with the supine position. Conclusions Changing body position leads to significant changes in regional lung ventilation, objectively assessed by FRI The volume based on the imaging parameters in the dependent lung is smaller in the lateral position than in the supine position. In right lateral decubitus position, airflow distribution is greater in dependent lung compared to the nondependent lung. Trial registration: The trial has been submitted to www.clinicaltrials.gov with identification number NCT01893697 on 07/02/2013.

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Influência da variação dos decúbitos laterais na deposição pulmonar de aerossol

Abstract: Background: The lateral decubitus position leads to the greatest changes in regional pulmonary ventilation and is used in respiratory

Cited by 15 publications

References 27 publications

Effects of dorsal and lateral decubitus on peak expiratory flow in healthy subjects

Effects of dorsal and lateral decubitus on peak expiratory flow in healthy subjects

Influence of Mechanical Ventilation Modes on the Efficacy of Nebulized Bronchodilators in the Treatment of Intubated Adult Patients with Obstructive Pulmonary Disease

The effect of posture on airflow distribution, airway geometry and air velocity in healthy subjects

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